Fissure refers to a small tear or wound inside anal canal. This problem is generally caused by hard stool trauma to anal skin. Fissure with the skin tags leads to painful bleeding, owing to a small cut at anal margin. The disease is generally associated with the skin tags, and is mistakenly called piles. After healing, the skin tags leave behind a small nodule that is known as sentinel pile. Due to an attack of fissure, this nodule enlarges and becomes a cause of worry for patients.